Ob-Gyn Coding Alert

Question: We billed a 59820 – DX O02.1. The patient was still bleeding, so we brought her back 2 weeks later and performed a 58558 with DX-O02.1. Can we bill a 58558 when my doctor did the hysteroscopy for retained products of conception?

Texas Subscriber

Answer: No, because at this point, she is still in the "incomplete" abortion stage. You should be billing 59812 (Treatment of incomplete abortion, any trimester, completed surgically) and no longer bill O02.1 (Missed abortion), since there is no longer a fetus present. Per the newest ICD-10 guidelines, "Subsequent encounters for retained products of conception following a spontaneous abortion or elective termination of pregnancy, without complications are assigned O03.4, Incomplete spontaneous, abortion without complication, or codes O07.4, Failed attempted termination of pregnancy without complication." As this missed abortion has now become an incomplete abortion due to the retained products of conception, the correct diagnosis code would be O03.4.

You can possibly bill the hysteroscopic approach as 58555 (Hysteroscopy, diagnostic [separate procedure]) if there was a medical indication for doing the procedure via the hysteroscope, or you could also consider adding a modifier 22 (Increased procedural service) to 59812 to account for the additional work involved in using the hysteroscope.

The American Congress of Obstetricians and Gynecologists (ACOG) has not addressed the use of a hysteroscope when doing procedures to remove retained products of conception, but you might want to write to them to see what their take on this is. If the procedure had been done more than 90 days following the initial surgery, a member of the ACOG coding committee has recommended using either 58120 (Dilation and curettage, diagnostic and/or therapeutic [nonobstetrical]) or 58558 (Hysteroscopy, surgical; with sampling [biopsy] of endometrium and/or polypectomy, with or without D&C).

For your diagnoses, you need to refer to the physician's notes for the specific complication as the ICD-10 guidelines do not currently address coding for retained products of conception following a missed abortion. You will report O94 (Sequelae of complication of pregnancy, childbirth, and the puerperium). Under ICD-10 Guidelines, the late effects code is reported when an initial complication of a pregnancy develops a sequelae requiring care or treatment at a future date. It may be used at any time after the initial postpartum period.